be increasing with preternatural rapidity; a rapidity that could not be predicated of twins, of polypus uteri, or any tumor. We know that the-case is one of hydatids whenever, upon Touching, we can find a softish mass in the cervix which bleeds upon being rudely pressed, and which discharges upon the finger or the napkin specimens of the aqueous vesicles.

As soon as the diagnosis is made, one is ready to take advantage of the commencement of any dilating pain, to provoke the earliest possible discharge of the hydatid mass. This may be done by introducing the index finger into the os uteri far enough to reach and break up the mass. It mostly happens here, as it does in turning out coagula from the womb, after labors, that, as soon as a portion, even a small one, is broken off and discharged, the uterus begins at once to contract upon its now lessened contents, so that, in general, the whole product rushes forth from the violently contracting organ. When, upon the discharge of a quantity of the hydatid mass, the labor-pain ceases too soon, it is well again to break in pieces the rest, so that, when the pain next comes on, there may be less resistance to its expulsion. The Touch reveals to us the truth at last, as to whether all the product is driven off or not.

In any case where it might be desirable to expedite the expulsion, resort should be had to a colpeurynter.

I have observed that, in the course of a labor for the expulsion of hydatids, the hemorrhage is occasionally most violent, and even alarming. The tampon constitutes an unobjectionable means of arresting such a too troublesome waste of the blood.

Intense constitutional irritation accompanies the hydatid pregnancy in those examples of it where the growth is violently rapid. The over-hasty development of the womb or matrix of the mass may be compared to a bursting process. I leave it to the ingenious Student to study out the problem of the amount of constitutional disorder and its signs, likely to be made manifest upon such sudden and preternatural impetuosity of the uterine growth.

Moles.-Moles are altered ova. In the case of a false pregnancy or Mola, as it is called, we are to presume the conception was normal, but that, upon some accidental failure of the development of the embryo or the secundines, the embryo perished and disappeared. In the mean time, by the operation of a principle of vitality communicated through the uterus, the mass continued to exist and to grow, until the womb, no longer tolerant of the foreign body, must commence a series of contractions, by force of which it is expelled. The mole, like the

hydatid, is called a false conception. Neither of them is a false conception; but a true conception, changed afterwards by some accidental diseased action.

Physometra.-There is said to be a false pregnancy called physometra or wind-pregnancy. I have recorded my opinion as adverse to this pretended state, in my Letters to the Class, and in a note to Colom bat on this subject at p. 372. I cannot conceive of a womb distended like a balloon with gas. Some of the reviews with which my Letters have been honored find fault with my recusancy as to Physometra and Hydrometra. I receive with the greatest respect, and even thankfully, the strictures that have appeared together with a certain flattering amount of commendation of that work. Notwithstanding the remarks of my critics, I feel constrained to maintain the opinions I there expressed, to which I beg leave to refer the Student.

Authorities, however respectable, are after all to be regarded only as so many men or women. Authorities are not always lawgivers, but if they were, I must confess that I owe obedience to the higher law of my own perception.

The curious on this matter of Physometra may consult p. 605 of Schenck's Obs. Med. rariores. Fol. Lugd. 1644.

Hydrometra.-This is a state in which the womb becomes filled with water. The woman, supposing herself pregnant, suddenly finds herself deluged with water that, as is pretended, gushes in a torrent from the uterus, whereupon the signs of the pregnancy vanish away. Inasmuch as I cannot imagine the state of hydrometra, independent of some enormous sac, cell, vesicle, or acephalocyst in which it is contained, and as the supposition of such vast cells is impossible, I adhere to the opinion that Hydrometra is an hypothesis merely. I prefer to suppose the case to be one of over-distended bladder, and the water of the supposed hydrometra to be urine. If the womb should become affected with atresia of the os tincæ or cervix, and it should then fill with a great quantity of fluid, that fluid could not be water. I respect fully, therefore, claim to adhere to the dissenting opinions expressed in my Letters, to which again I refer the Student.

Abortion.-The ovum, however well protected by its recondite situation against the operation of any extrinsic causes of destruction, is, nevertheless, obnoxious to several influences that may cause its miscarriage. There are also many intrinsic causes that tend to effect its death; for, since the embryo is composed of a structure, and

has functions that are vastly complicated and mutually dependent, it must be liable to disorders that may interrupt its growth, or health, and at last cause it to be thrown off as an abortion.

The embryo is so delicately organized, that very slight changes in the solids or fluids which compose it are sufficient to determine its destruction.

Its blood, out of which all its tissues are composed, is moved by its own powers of circulation, and it must, like all other living beings, be subject to engorgements, inflammations, hemorrhages, and all the other maladies that consist in derangements of the circulation.

Such a creature might perish from very slight faults in the power of the omphalo-mesenteric vessels, or the umbilical vessels-and unequable development of its more important internal organs doubtless serve, in many instances, to deprive it of vitality. Of the vast number of cases of early abortion, I presume a large majority depend upon disorders of the embryo itself, and not upon disorders or accidents happening to the mother.

While this is probably true, it is to be observed that the union of the placenta to the surface of the womb is so slight, that it is easily peeled off; so that a blow upon the region of the womb may destroy its connection, and blood become, at once, effused betwixt the placenta and the uterus; if a great quantity be effused, the whole surface of the placenta may be speedily detached or loosened, and of course, the ovum, now deprived of the sources of growth, must perish.

A sudden and very violent excitement of the blood vessels, as by surprise, anger, &c., may cause the effusion of blood from the placental superficies of the womb. A contraction of the womb may break the connection. A violent concussion of the body, as by falls, jumping or rude motion in carriages or on horseback, may cause a detachment to take place; or the membranes of the ovum may be so weak and delicate as to burst upon very slight compression of the womb, as in coughing, straining at stool-upon any sudden and powerful exertion, as pulling, lifting, &c. Thus it appears that the abortion may be caused by the death of the embryo; by disease of the secundines; by sudden violent movements of the blood, causing the effusion of that fluid behind the placenta; by direct violence, or by the discharge of the water of the amnion.

If the ovum be ruptured, there is a discharge of water from the vagina, the quantity of which will depend upon the age of the embryo. This is sooner or later followed by pain, and flowing of blood. The pains, which are uterine contractions, become more and more frequent

and considerable, until the ovum or its remains are expelled, when the bleeding begins to diminish, and, for the most part, the pain returns no more. If any cause should have been applied that could detach a portion of the placenta without rupturing the ovum, many hours, or even several days might elapse, before the blood that follows the detachment should appear at the orifice of the vagina: the blood must first force its way betwixt the chorion, and the internal surface of the womb; but as soon as it reaches the orifice, it falls into the vagina, and then there is what is called a show. If the foetus perishes by an internal disease, or in consequence of some disorder that happens to seize upon any part of the ovum, the further development of that ovum, or of the embryo, ceases, and it is cast out by the contractions of the womb, sooner or later, according to circumstances. For the most part, the ovum, soon after it has lost its vitality, becomes an irritant or ex· citant of the womb. On not a few occasions, however, the dead ovum remains within the uterine cavity for weeks or even for months, without exciting its contractility-cases that are among the most embarrassing, on account of the diagnosis, that the obstetrician can possibly encounter. The dead ovum of three months may not be expelled until the seventh or eighth month of pregnancy. It undergoes no putrefaction, unless the membranes have been ruptured; in which case, it cannot remain very long undischarged.

There are some individuals in whom there seems to be so great an irritability of the muscular fibres of the womb, that the presence of the fruit of a conception never fails to bring on the contractions before the completion of the term of pregnancy; and I apprehend that this excessive irritability is among the common causes that produce abortions. This view seems to be maintained by a reference to what happens in those who have already miscarried, since such females are found to be greatly disposed to miscarry again, at about the same period as that at which they had sustained the first misfortune; which appears to me to indicate that the repeated accidents of this kind are attributable, rather to an excessive or abnormal irritability of the womb, than to any of the other circumstances that are enumerated as causative of abortions; for it is far more reasonable to suppose that the same uterus is endowed with too great a degree of muscular irritability, than to suppose that several successive germs should be so constituted as to perish always at about the same period.

A woman becomes pregnant by the fecundation and subsequent fixation of a deposited ovulum. The act of fecundation can only take place after the ovi-posit has happened. The conception does not necessarily put a stop to the periodical

development of ovarian ova-nor to their maturation and fall. But a woman who menstruates because of her ovi-posit, will tend to menstruate at regular periods, though she may have already conceived in the womb. Some women have this tendency so strongly, that they do actually menstruate during the earlier months of their gestation. Mrs. K. menstruated until the eighth month of her pregnancy.

Every woman who menstruates in her pregnancy is trying to miscarry; and she would miscarry if the monthly hyperæmia, giving rise to menstrual hemorrhage, should cause the outflowing blood to destroy the connection between the ovum and womb. If she does not miscarry in such cases, it is because the blood escapes from the uterine superficies below the surfaces occupied by the ovum in the cavity of the organ, or because the connection of the ovum to the womb had become a sufficient bar to the discharge of blood from its uterine vessels.

The above may serve as an explanation of the very common opinion that a woman is most liable to abortion at periods coinciding with the menstrual effort, and there is good reason to believe that a great number of abortions do take place at those conjunctures. It is reasonable to suppose that the periodical hyperæmia of the reproductive organs that causes menstruation would, should it occur in pregnancy, expose the woman to the risk of miscarriage-and it is equally reasonable to take especial precautions against such an occurrence for those women who have, on former occasions, suffered the loss of the ovum, at or near to the menstrual periods, and without any other assignable cause than the menstrual effort.

Whenever, in abortion, the contents of the gravid womb come to be expelled from its cavity, that expulsion is effected by a real labor, often severely painful, and requiring for its completion many hours of greater or less suffering; sometimes many days.

I have had the medical charge of the same women in regular labor and in abortion; and they have informed me that, for acuteness and severity of pain, the abortion has far exceeded the labor at term. This is not always, nor perhaps most generally, the case. The reason why some women suffer so acutely in miscarriages is, that the canal of the cervix uteri requires for its dilatation, in the early months, a great deal of power to be employed in forcing the embryo, which at that time is contained in the cavity of the body and fundus, down through the long narrow canal of the cervix uteri; and the distress produced by this dilatation of a long and rigid canal must often be as great, and might à priori be supposed as great, as that occasioned by the dilatation of the os uteri at term, which in the last days of pregnancy